HomeMy WebLinkAboutPermit Backflow Test 2006-6-14
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Status
Issued
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. CITY VI' ~rKlj~lJI'IELD'
Building/Combination Permit
PERMIT NO: COM2006-00735
ISSUED: 06/14/2006
APPLIED: 06/14/2006
EXPIRES: 12/14/2006
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 715 McKenzie Crest Dr
ASSESSOR'S PARCEL NO.: 1703234306400
Springfield TYPE OF WORK:
TYPE OF USE:
PROJECT DESCRIPTION: Backllow.
Owner: MCMAHON PATRICK L & JUDITH A
Address: 715 MCKENZIE CREST DR
SPRINGFIELD OR 97477 ,(7'
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I CONTRACTOR INFORMATION I
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Contractor ~(;S ~ License
SCHELSKYS L~~~E AND IRRIGATI 12170
~ ;{. ~'~lhlbING INFORMATION I 0
{$'1 <<<(;~.... ~~,~
# of Units: 'v <<) '\~C:, ~\S # of ~~'ries:' ~ 4,0 'V~ \0(;S' . Lot Size:
Primary OCClIp:ncy Group: ~~ 13:' 8:>~ Height of Structure ;fro ~~ <00' 5:l\)"-o~q Ft 1st Floor:
Secoudary Oci!upancl.9ro~~ -\:,~"5 {> ~ S;)' Type of Heat: ,ro~ O,ro ~ro 0)'0'1; ",,,,<0 "Sq Ft 2nd Floor:
Primary Constru.,,~~~,,-~ \:)<<:- ~(;S Water Type: ,# xs-ro ",ro<O {t' ro ,v o"'S,q:-ft Basement:
Secoo;l!ary Co~~t61'Cti~~~~ Q,,<(; Range Typ~~ 'Q4, ro ,v ~ 0 ~'S' }..if 0cSq Ft Garage/Carport
# of Bedrooms: ,\~~,\Y:-(;S K,~ \:)~ Energy ~ffi:s>O ,,~o<; 0.::,<:$",<00 ",:--Qi o~' Sq Ft Other:
~ ~.$i- 0..":> Sprink~d~li'i1~,iri~.;1 0<::1' . 'nta,~ t>:\ Occupant Lnad:
r _C'\~. .....v 1,0' ~ ,e; _~ _ G ....(Q. .~~" oS>'
v~, I DEVE1';OPME~T;'iNFORMATioN ',.9-'v
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Overla)1'Dis't: ,'{'o'" xs-ro.~
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"'i!'trept~'free~Rqa: ~Qi
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PaveIDDQve~qil:v
% of Lot qoverage:
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9
Contractor Type
Landscape
Expiration Date
08/31/2006
Phone
541-744-7135
REQUIRED PARKING
Frontyard Sethack:
Side 1 Sethack:
Side 2 Setback:
Rearyard Sethack:
Solar Sethacks:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer A vailahle:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation DescriDtion I
Descriptinn
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I of2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-00735
ISSUED: 06/14/2006
APPLIED: 06/14/2006
EXPIRES: 12/14/2006
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees tiWLI
$4.50
$3.60
$14.00
$31.00
6/14/06
6/14/06
6/14/06
6/14/06
Receipt Numher
2200600000000000835
2200600000000000835
2200600000000000835
2200600000000000835
Fee Description
+ 10% Administrative Fee
+ 8% State Surcharge
Backllow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
Total Amount Paid
$53.10
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
Backllow Device: Prior to covering and provide a copy of the test report on site at the time of iuspection.
By signature, I state and agree, that I have carefully examined the completed applicatiou and do hereby certify that all
informatio'n hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinauces ofthe City nf Springfield and the Laws nf the State of Oregon pertaining to the work descrihed herein, and
that NO OCCUPANCY will be made of any structure without permission ofthe Community Services Division, Building Safety.
I further certify that only contractors aud employees who are in compliauce with ORS 701.005 will be used ou this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readahle from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
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Owuer or Contractors Signature
b /11/6 C.
Date
Pa~e 2 of2
225 nrrH STREIT. SrRINCrIELD, OR 97477 . rH:(541)726-3753 . FAX: (541)726-3689
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BACKFLOW PERMIT IS $53.10 (includes Permit Fee, State Surcharge & Administrative Fcc)
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State
Construction Contractors Registration #
63:3'0
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Expires
By signing this permit/application, I agree to call for an inspection once the backflow prevention
devise has been installed and is visible for inspection (726-3769). I also state that all information on
this permit/application is correct.
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For Office Use
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Checked for Historical Status
Shared Drive (f: )IBuilding FonnsJBackflow Prc:venlion 1..Q6.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2006-00735
COM2006-00735
COM2006-00735
COM2006-00735
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
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<..iiIit of Springfield Official Receipt
.Iopment Services Department
Public Works Department
2200600000000000835
Date: 06/14/2006
Description
Backflow Device I
Minimum/Adjustment Plumbing
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
DARREN S SCHELSKY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
jmp 214103 In Person
Payment Total:
Pa~e 1 of I
10:30:53AM
Amount Due
14.00
31.00
3,60
4.50
S53.10
Amount Paid
$53,10
S53.10
6/1412006